Impact of high dose chemoimmunotherapy after surgery on the overall and disease-free survivals in advanced stage malignant melanoma.

BACKGROUND: To investigate the impact of high dose chemoimmunotherapy in addition to surgery on the cumulative survival and disease-free survey of malignant melanoma patients. METHODS: A total of 86 malignant melanoma patients [35 females (40.7%), 51 males (59.3%), mean age: 55.5] were treated according to their stages between Februrary 1997 and June 2007. After surgery, adjuvant immunotherapy was applied to patients in Stage 2, while adjuvant chemotherapy and adjuvan immunotherapy were administered to those at Stages 3 and 4. RESULTS: Overall rate of mortality was 31.4% (27/86). The most frequent postoperative complications were wound infection (n=8, 9.3%) in the early period and lymphedema in lower extremities (n=4, 4.6%) in the late period. Temporary and tolerable complications ensourcing from chemoimmunotherapy were encountered in 9 (10.4%) patients. The survival rates and disease-free periods of combined treatment protocol were found to be similar to those in ECOG 1684 and ECOG 1690 studies. CONCLUSION: Adjuvant immunotherapy and chemoimmunotherapy seem to improve overall survival and disease-free survey in malignant melanoma. Further clinical studies are necessary to demonstrate the actual effectivity of this promising protocol in the management of malignant melanoma.

Title.

AIM: We investigated the efficacy of topical phenytoin and capsaicin on random pattern dorsal skin flaps in rats. MATERIAL AND METHOD: Twenty one Wistar rats were used in the study. Random-pattern McFarlane dorsal flaps 3 cm x 10 cm were raised in all the rats .A plastic barrier was placed between the flap and its donor site The flaps were sutured back to the original position with 4/0 nylon sutures. The rats were randomly divided into three groups (n=7). Group I was given only gel, Group II was given 2 gr gel with % 1 phenytoin and Group III was given 2gr gel with %0.1 capsaicin and pure gel. Capsaicin application were used twice a day on 2 consecutive days,subsequently Group III was given only gel on 5 consecutive days. Phenytoin and placebo application were used twice a day on 7 consecutive days. Images were transferred to a computer and ratio of flap necrosis area to total flap area was calculated RESULT: The mean percentage of necrosis in the flaps were 37.27±3.86%, 36.3±6.2%, 23.4±5.9 % in the control, phenytoin and capsaicin groups, respectively. The percentage of flap necrosis was significantly lower in the Capsaicin Group compared to the control group (37.27% vs 23.4%, p<0.01). Although phenytoin had a lower mean percentage of flap necrosins than the control group, this difference was not significant (37.27 vs 36.3 , p>0.05). CONCLUSION: We showed topical capsaicin increased the random pattern skin flap survival in rats whereas topical phenytoin had no positive effect. We believe that further studies are required to investigate the efficiency of topical phenytoin applications. KEY WORDS: Capsaicin, Phenytoin, Skin flaps.

Local recurrence and survival rates after extended systematic lymph-node dissection for surgical treatment of rectal cancer.

BACKGROUND/AIMS: Extended systematic lymph-node dissection (ESLND) is a surgical procedure aimed at decreasing the local recurrence rate of rectal cancer and increasing the survival rate. However, it is criticized because it has not shown the expected effects on survival, and it has been shown to increase the proportion of complications in rectal cancer surgery. This study was designed to determine incidence and patterns of recurrence after curative resection with or without ESLND for rectal cancer. METHODOLOGY: A total of 184 patients with rectal cancer were reviewed with respect to surgical procedures, local recurrence and survival rates. RESULTS: 170 of 184 patients with rectal cancer were administered curative surgical resection. ESLND was added to the surgical procedure of 24 of these 170 patients. The local recurrence rate of the patients who did not receive lymph-node dissection was 15%, and the survival rate over 5 years was 58.9%. The local recurrence rate of the patients receiving ESLND was 12.5%, and the survival rate over 5 years was found to be 55.7% (p>0.05). CONCLUSIONS: Because ESLND is a procedure added on to curative resection in the surgical treatment of rectal cancer, it increases the general anesthesia and length of surgery, and it is possible that some complications due to the operation itself may arise. In the current study and in a large amount of research in the literature, a statistically significant effect on the survival rate has not been found. In conclusion, the opinion has been reached that ESLND does not have an important benefit in the curative surgical treatment of rectal cancer.

Neutrophil-lymphocyte ratio as a predictive factor for tumor staging in colorectal cancer.

BACKGROUND/AIM: In the preoperative period, simple methods to identify the tumor stage of colorectal cancer patients are needed. In recent years, the neutrophil-lymphocyte ratio (NLR) has been used as a predictive parameter for systemic inflammatory response in many different clinical entities. This study aims to determine if the NLR predicts the tumor stage in colorectal cancer patients in the preoperative period. MATERIALS AND METHODS: A total of 206 patients diagnosed with colorectal cancer and admitted for surgical treatment over a 6-year period were identified from a retrospectively maintained database. NLR was calculated from preoperative full blood counts. NLRs were compared with the tumor stages as determined in histopathological reports and scanning tests to determine the extent of metastasis. RESULTS: We found NLRs to be statistically higher in patients with T3 and T4 tumors than in patients with T1 and T2 tumors (mean: 5.261 vs. 4.499, respectively, P = 0.010). Similarly, we found statistically higher NLR values in the N1 and N2 groups than in the NO group (mean: 6.597 vs. 4.501, respectively, P < 0.001). Additionally, NLRs were statistically higher in M1 patients than in MO patients (mean: 8.261 vs. 5.158, respectively, P = 0.004). CONCLUSION: In the preoperative period, NLR was found to be a valuable predictive parameter for tumor staging in patients with colorectal cancer, thus informing us as to the kind of tumor we will meet when we open the abdomen.

Comparison of 3D imaging and 2D imaging for performance time of laparoscopic cholecystectomy.

OBJECTIVE: The aim of this study is to evaluate the effect of the Viking 3-dimensional (3D) system on performance time of laparoscopic cholecystectomy. METHODS: Twenty-two patients were included in the study. The groups were standardized using a multiparameters filter (MPF) depending on preoperative ultrasonography and perioperative exploration findings. The 11 patients operated with the Viking 3D system (group A) were compared with 11 patients operated with the Olympus 2D/HD system (group B). RESULTS: The mean performance time was 20.63 ± 5.66 and 30.0 ± 6.03 minutes in the group A (3D) and group B (2D), respectively (P<0.01). CONCLUSIONS: The 3D imaging systems may cause a significant reduction in the performance time of laparoscopic cholecystectomy.